Health Insurance: A-Z Guide

The A-Z guide to buying private health insurance

Everyone should have health insurance, however actually finding the right form of coverage can be a painstaking task. In this article we take you through the health insurance: A-Z guide whilst highlighting the various policy types and their pitfalls.

You should consider private health insurance if:

you are not covered by a company or group health insurance program

you are covered by a national health system or some other universal health system

you would like to have the option of private care where you currently live

you would like to have treatment for a specific problem in another country

The basic features of private health insurance

Comprehensive coverage – this includes “in-hospital” care and services, as well as the services of doctors, lab tests, x-rays, scans, etc. in a non-hospital setting.

Basic coverage – this is limited to all care and services relating to an “in-patient” hospital stay only.

Policies often have “deductibles” or insurance policy clauses which relieve the insurance company from the responsibility of paying on a claim until a specific euro loss is reached. In some cases, policies may have limits on reimbursement, or on where the care is provided.

Heath insurance policy rules

When submitting a claim, you may be asked for proof that the problem you just treated wasn’t a pre-existing medical condition at the time you applied for the policy. A pre-existing condition generally means a medical condition, which is currently being (or was previously) treated, and any condition associated with it. If the insurer decides it is a pre-existing medical condition, they may deny the claim.

Fully-underwritten policies often require detailed health questions to be answered; this may include a request for a “doctor’s report”. Based on the information received, the insurance company may decide to:

accept you with no exclusions or conditions

accept you with an increased premium

accept you with an exclusion for a specific medical condition

reject you

It always makes good sense to disclose a pre-existing condition on your application form even if the application doesn’t specifically request you to do so.

Your age

Insurers may automatically reduce benefits, charge extra premiums, or even discontinue your coverage when you reach a specific age.

Health insurance policy exclusions

Travel

Depending on the policy conditions, health care coverage may be excluded if you travel against the advice of a physician, or while you are on a waiting list for treatment.

Pregnancy and childbirth

Some policies exclude pregnancy and childbirth completely, whereas others exclude them only for the first 12 months of the policy. In cases where the pregnancy and birth are covered, some policies automatically exclude the first 15 days of a newborn’s life, while others cover only the first 14 days of life.

Chronic illnesses

Policies may specifically exclude or limit the coverage of conditions which are, or become chronic, after having purchased the policy. For example, an asthma attack (acute illness) may be covered, but not ongoing asthma problems (chronic illness).

Limited coverage

Duration

Coverage may be limited for any single accident or illness to the first 12 months of treatment following the onset of that accident or illness.

Where you are

Policies may have limitations on where you can go for care treatment, and may charge different premiums based on the region(s) you select.

Health insurance claim process

Pre-certification

Many insurers require that you obtain prior approval before a planned hospitalization; a penalty of reduced benefits may be enforced if this is not done. In the case of emergencies, notification is required as soon as possible after hospitalization.

Non-hospital bills

In most cases it is necessary to pay physicians, labs, etc out of your own pocket and thereafter submit those bills as proof of payment to the insurance provider.

Submitting health insurance claims

Some policies require a completed claim form to be submitted whereas others accept the original bill for reimbursement. In almost all cases, it is recommended that you obtain the bill in English, or alternatively supply an English translation; this tends to smooth the process of reimbursement.

Emergency help

Almost all insurers offer the services of an International Help Centre, 24 hours a day, 7 days a week. The Centre can refer you to an English-speaking doctor and/or hospital and assist in the event of an emergency requiring medical evacuation.

Medical evacuation

This is a useful feature if you are in a country/region with a healthcare system that is below par. If the emergency can not be treated locally, you will be evacuated to the nearest major facility capable of providing an acceptable standard of care.

Payment of premiums

Premiums are normally payable on an individual basis, however some policies do offer family cover. Others offer free coverage to pre-teen dependent children, on the condition that one parent is already covered.

Premiums may vary on the basis of where you live or where you wish to have treatment; they may also increase as you age. Payment of premiums is usually made by direct debit transfer or credit card collection.

Renewing coverage

The guaranteed renewal of an insurance policy is fundamental to the selection of that policy.

You should never cancel your health care coverage if you have developed a medical condition, as such a condition would be deemed pre-existing if you were to apply for another policy in the future.

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AXIS Consultants are a team of Overseas Pensions experts helping expats make the best investment decisions about their retirement.

Important notice

The contents of this website are for educational and information purposes only. No part of this website is to be considered as an offer, inducement or recommendation to invest. AXIS Strategy Consultants are a fully authorised “Courtiers d’Assurance” in France, reg. no. 08 044 720